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Myelin repair and stem cells get attention at AAN Meeting

Tremendous advances in the understanding and treatment of MS were presented last week at the AAN Meeting in Vancouver. (Feel free to browse summaries of the presentations here – no registration is required). One of the areas getting the most attention was myelin repair. Myelin wraps around nerve fibers, like insulation on an electric cord. In MS the myelin is damaged, disrupting electrical signaling and making the nerves more susceptible to damage that leads to progression. Myelin repair is seen as a promising approach for restoring lost function and slowing down – or even stopping – progression.

We have recently come to learn that the brain is full of spare cells waiting to be called into the service of repairing myelin. In early MS, these cells find their way to areas of damage, wrap around nerve fibers and repair myelin. However, as the years go by, they lose this ability. Finding ways to stimulate the brain's ability to repair itself is an area of intense study and several notable presentations were made at last week’s meeting.

First, I would like to share they very promising work presented by Dr. Ari Green of the University of California, San Francisco. As announced late last week, he led a small, phase II proof of concept clinical trial to test whether an over-the-counter allergy medication, called clemastine, could promote myelin repair. The team measured the speed of nerve transmission in the optic (eye) nerve because it’s is easy to measure and is a very good indicator that myelin repair has occurred. Participants in the trial had a history of optic neuritis, where the myelin in the optic nerve is damaged.

In this trial, the nerve signaling speed increased when the participants were taking clemastine. This increase in nerve signaling is a strong indication that myelin repair has occurred. It is important to note that the dose used in the study exceeded the maximum recommended dose and was accompanied by side effects including fatigue. While it might be tempting, I would not recommend taking this medication until we know more about the risks and benefits. If you decide to not take this advice, I urge you to talk with your healthcare provider before taking any new medication.

You might be interested to know that the idea of promoting myelin repair with an anti-histamine drug came from MS Society sponsored research performed by Dr. Jonah Chan (a colleague of Dr. Green’s from UCSF). Dr. Chan discovered that myelin-making cells would wrap myelin around artificial nerve fibers as long as they were the proper size and the cells were properly stimulated. This discovery lead to a sophisticated screening tool that enabled the team to test whether any of thousands of FDA-approved medicines could stimulate myelin-making cells to grow new myelin. This screening tool identified clemastine as having myelin repair potential, and earned Dr. Chan the first Barancik Prize for Innovation in MS Research.

There are a number of other myelin repair agents in clinical trials for MS, and many others in pre-clinical testing stages that look like they are getting ready for first tests in people. So this area of research is really taking off.

Another approach to myelin repair is the transplantation of myelin repair promoting stem cells. Advances in this approach were reported by Dr. Saud Sadiq from the Tisch MS Center in New York, who is attempting to promote myelin repair by transplantation of bone marrow derived stem cells into the spinal cord. Dr. Sadiq presented preliminary findings from treatment of 13 people with progressive forms of MS. He reported no serious adverse events so far (the trial has not yet been completed). There are also hints that some people may be responding to the treatment. But the trial is not designed to detect a clinical benefit, so caution should be used when interpreting these results. I look forward to the completion of this study and the publication of the full results.

Because the treatment so far, appears to be safe, the team has announced plans to advance this treatment to a phase II trial. Phase II trials are designed to provide evidence for effectiveness (as well as safety). I applaud Dr. Sadiq for his efforts to explore this innovative approach to the treatment of progressive MS, a form of MS that currently has no disease modifying treatment.

Bruce Bebo, PhD

Bruce Bebo, PhD, is Executive Vice President, Research at the National MS Society, and was previously a research immunologist focusing on the influence of sex hormones on MS. He is a driven and passionate Society volunteer, successful fundraiser and advocate, fueled in part by the fact that his mother had MS.

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This is such encouraging news, particularly for those who have been waiting and waiting for anything that can alter the course of progression. Thanks to the researchers and the supporters of the research, to those who disseminate hopeful news, and to those who are affected by MS who live for reports like this.

These are all wonderful things that are in the works, but all they have for MS people now is some new medicine. I'm not even 50 yet, and there won't be anything in my lifetime. It's all a bunch of bunk.

Please hurry I want to stand up and walk. I use to get sinus infections every year but this year ,, I got my first one in 15 years. Plus I am blind in right eye due to a sewing machine needle broke off flew into My eye. Spent a month in hospital. So this could work. Botox is helping my pain.

Thank you for sharing this interesting news from the Conference. It is very encouraging to know that they are working on ways to repair the myelin. It may not be in my lifetime that the medication is tested, approved and available, but I pray it will be effective some day and save future generations from the trials of living with MS. Please keep up updated as this research moves forward. Thank you.

I am the mother of a MS 2nd progressive patient, I suffer from Scleroderma(been research patient for Royal Free London many years) I was born Pyloric Stenosis only 2nd girl to have Rameses? Op in 1943 in UK, I think now the auto immune problems originate from our own food processing factory stomach being the problem, has this lead already been considered? I was told if my 1st born was male could have Pyloric as a young Mum, all those years ago. Recently been in contact with family with Crohns history all seemed linked. Thank you Anita

I have periapical neuropathy.. I am not a diabetic. Is there any research going on to help this nerve problem. I take Gabapentin 1800 mg per day and 75 mg Lyrica daily. Seems to get steadily worse. I am losing hope, this is a terrible situation, we do not know the cause.

I'm curious if any studies are being done on how the Zika virus may affect people with autoimmune diseases? Many of the more severe symptoms of Zika are very reminiscent of the symptoms of multiple sclerosis.

First, thank you for selecting my daughter for a $1,000 scholarship for children of MS. I have recently been diagnosed as secondary progressive. What is the latest tx, as I have been taken off of copaxone. Any thoughts on gut "bacteria" and fecal transplants? AnneMarie Riether MD 1999 National MS Achievement Award Recipient

Why are we doing this kind of research when there is a doctor in Italy that has a cure for it. Shouldn't we be figuring out what he has done and make it avaliable here in the us. That only seems logical to me.

It is my understanding that once the myelin is stripped away, the nerve fibers themselves get damaged. Myelin repair is not enough; nerve fiber repair is also needed. I'm 30 years post diagnosis. I'm a full time wheelchair user and have significant cognitive impact. Please work on nerve fiber repair!!

I was diagnosed with MS on January 6, 1972; prior to that the symptoms that I had were "all in my head". I was in the ICU for several days and in the hospital for, I believe, 9 days in all. No MRIs then and the treatment was Prednisone, lots of that. From time to time, I was told that a new treatment would be available in a few years, I used changes in my diet and a few other things that helped, I incorporated these items and walking, when I was able to walk, and wonderfully, after many ups and downs, I can walk now. I tried several of the new treatments as they came along, but I had bad reactions. There have been doctors that listened to my point of view and there are the control freaks who seem to be "my way or the highway" sort of people. There have been times more recently, that I have had to point out that I have had MS since before they were born.I do what I need to to stay pretty darn healthy. Life is and has been good, to me, albeit there have been difficult and scary times. Jean

I am newly diagnosed. My first treatment attempt was Copzxone and oddly enough I ended up having two violent reactions, 'serum sickness' (as my Neuro termed it). I need to choose another treatment and don't mind saying that reading over the list is daunting and scary to me. I wondered the whole time what, if any, research has been done with stem cells and or myelin repair. This is very encouraging to read.

Dr. Sadiq is my man! I have been with him for 16 years. He has always been there for me. I know of no one who has a more caring heart. I drive an hour and a half to see him. And as much as that kills me, his warm smile and out reached hands make forget the last two hours and open up and talk so frankly. I have never had a Doctor like Dr. Sadiq.